Extracranial atherosclerotic carotid artery disease: evaluation of non-breath-hold three-dimensional gadolinium-enhanced MR angiography.
OBJECTIVE
The purpose of this study was to compare the diagnostic information provided by a combination of two-dimensional and three-dimensional (3D) time-of-flight (TOF) techniques with that provided by non-breath-hold 3D spoiled gradient-echo gadolinium-enhanced MR angiography.


METHODS
Fifty patients suspected of having extracranial atherosclerotic carotid artery disease were examined with all three imaging techniques using a 1.5-T MR imaging system. Three observers independently and retrospectively measured the degree of stenosis according to the North American Symptomatic Carotid Endarterectomy trial criteria. The observers were unaware of the results of other MR imaging pulse sequences and digital subtraction angiography. The standard of reference was established by digital subtraction angiography. Results were evaluated with receiver operating characteristic curve analysis. The degree of interobserver agreement was determined using pairwise kappa statistics.


RESULTS
The grading of carotid artery stenosis as measured by the area under the receiver operating characteristic curve was less accurate with non-breath-hold 3D gadolinium-enhanced MR angiography than with TOF imaging. Interobserver variability was greater for non-breath-hold 3D gadolinium-enhanced MR angiography than for TOF techniques.


CONCLUSIONS
Routine evaluation of carotid artery stenosis at the level of the bifurcation using non-breath-hold 3D gadolinium-enhanced MR angiography is less accurate than is TOF imaging and is therefore not recommended. The weakness of this technique may be due to problems in timing the injection of gadolinium and the masking of the carotid bifurcation by the venous jugular system.
Slosman
F
F
Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
Stolpen
A H
AH
Lexa
F J
FJ
Schnall
M D
MD
Langlotz
C P
CP
Carpenter
J P
JP
Goldberg
H I
HI
D000368:Aged; D015901:Angiography, Digital Subtraction; D001161:Arteriosclerosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D015588:Observer Variation; D012372:ROC Curve; D012189:Retrospective Studies
D003287:Contrast Media; D019786:Gadolinium DTPA